Disposition

Patients with GI hemorrhage will require hospital admission, and early referral to an endoscopist is advisable. Corley and colleagues 24 found five variables to be independent predictors of adverse outcomes in upper GI bleeding: initial hematocrit less than 30 percent, initial systolic blood pressure lower than 100 mm Hg, red blood in the NG lavage, history of cirrhosis or ascites on exam, and a history of vomiting red blood. Such patients are more likely to require a higher intensity of inpatient care.

On the other hand, other authors have attempted to identify a low-risk subset of patients who might be managed as outpatients. Rockall and coworkers 25 developed a risk score for upper GI bleeding, based on age, presence of shock, comorbidity, diagnosis, and endoscopic findings, to identify a low-risk population. Longstreth and Feitelberg26 developed similar guidelines. Of note, both of these recommendations are based on the performance of endoscopy prior to discharge to classify patients accurately.

Dealing With Back Pain

Dealing With Back Pain

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